During the recent election, the Liberals got into trouble for wrongly attributing a statement undermining public health care to Prime Minister Stephen Harper.

The Conservatives reacted with indignation and, in the back and forth that followed, avoided the question of Harper's position on medicare entirely. But Stephen Harper has a long record of opposition to public health care and support of private health services that has been well documented.

And it is important to remember that Harper once headed up the National Citizens' Coalition, founded in 1967 by Colin M. Brown, a wealthy health insurance salesman, to fight medicare. The NCC once predicted that public health care would kill Canadians. Under the Harper government, private health services have flourished in several provinces, unopposed, even though the federal government is obliged under the Canada Health Act to withhold funding for such behaviour.

So it is with trepidation that Canadians should anticipate the approach of 2014, the end of the 10-year health accord signed in 2004 between the federal government and the provinces, necessitating a new round of negotiations on federal transfer payments for health care.

The 2004 accord set out an extra $41.2 billion in dedicated funding for health care issues such as waiting times, expanding home care and dealing with high drug costs as well as a six per cent increase in health transfer payments each year form the federal to the provincial governments.

However, when the accord expires, this annual increase is no longer guaranteed. Many worry that the Harper government will take this moment to fundamentally change the nature of health care delivery in Canada, giving more authority to the provinces but finding ways to down load the fiscal responsibility at the same time.

University of Regina professor Greg Marchildon, former Executive Director of the Romanow Commission on health care warns this is the perfect storm to promote privatization of heath services: a federal government not committed ideologically to public services in the first place facing a debt and deficit and wanting to "disentangle" itself from health care, combined with upcoming provincial elections that might produce more right wing governments over the coming months determined to assume more authority over health care.

The Globe and Mail's Andre Picard warns that, instead of a long term deal with all 13 provinces and territories, we can expect a short (two year) extension of the current one, followed not by an omnibus deal, but a series of individual bilateral deals with each. He notes that for all his talk on the coming negotiations on the health accord, Stephen Harper has never committed to a first ministers' meeting nor to a single agreement with all the provinces and territories.

So it is essential that our movements for social justice begin now to prepare for this coming fight and put out our key demands for a single omnibus accord as well as what it should look like. The 2014 negotiations should be used to strengthen our publicly funded system, which has proven itself to be both cost effective and fair, and we should be calling for a "Canada Health Accord Plus" that includes home and senior care, aboriginal health and a pharmacare plan.

The soaring cost of prescription drugs is the single biggest factor in the rising cost of health care in Canada. The 2004 accord was supposed to deliver a program to bring catastrophic drug coverage to Canadians but it never materialized. A national pharmacare system could save the federal government over $10 billion by bulk buying prescriptions across the country at reduced prices.

Another hole to be filled is the lack of funding for seniors and home care; a real national program would provide alternatives that are both less costly and more humane than hospitalization for seniors.

And without a full federal/provincial/ territorial accord, will the funding for First Nations fall between the cracks? Health care on aboriginal communities in Canada is still often shockingly substandard. The 2014 accord must commit to dealing with this injustice.

Canadians cherish our public health care system. With a Harper majority, it is now urgent that we stand on guard for it, lest it be destroyed by stealth in complicated negotiations and lost in a myriad of betrayals.